GI pathology symptom based Flashcards
Diagnostic indications for upper GI endoscopy
- haematemesis/melaena
- dysphagia
- dyspepsia (>55yrs old, alarm symptoms or treatment refractory)
- duodenal biopsy (coeliac)
- persistant vomiting
- iron deficiency (cancer)
Therapeutic indications for upper GI endoscopy
- treatment of bleeding lesions
- variceal banding and sclerotherapy
- argon plasma coagulation for suspected vascular abnormality
- stent insertion, laser therapy
- stricture dilation, polyp resection
Upper Gi endoscopy pre-procedure
- stop PPIs 2 weeks pre op if possible
- nil by mouth for 6 hours beforehand
Sigmoidoscopy views:
the rectum and distal colon
Sigmoidoscopy preperation
Phosphate enema PR
Diagnostic indications for colonoscopy
- rectal bleeding
- iron deficiency anaemia (bleeding cancer)
- persistent diarrhoea
- positive faecal occult blood test
- assessment or suspicion of IBD
- colon cancer surveillance
Therapeutic indications for colonoscopy
- Haemostasis
- Colonic stent deployment (cancer)
- volvulus decompression (flexible sigmoidoscopy)
- polypectomy
Video capsule endoscopy
To evaluate obscure GI bleeding and to detect small bowel pathology
Dysphagia
Difficulty in swallowing and should prompt urgent investigation to exclude malignancy
Dysphagia - 5 key questions to ask
- Was there dificulty swallowing solids and liquids from the start?
- Is it difficult to initiate a swallowing movement?
- Is swallowing painful?
- Is the dysphagia intermittent or is it constant and getting worse?
- Does the neck bulge or gurgle on drinking?
Dysphagia - difficulty swallowing solids and liquids from the start
Motility disorder - achalasia, CNS or pharyngeal cause
Dysphagia - difficulty swallowing solids and then liquids
Suspect a stricture (malignant or benign)
Dysphagia - it is difficult to initiate a swallowing movement
Suspect bulbar palsy, especially if the patient coughs on swallowing
Dysphagia - swallowing is painful
Suspect ulceration of spasm
Causes of ulceration:
- malignancy
- oesophagitis
- viral infection
- Candida in immunocompromised
- poor steroid inhalor technique
Dysphagia is intermittent
Suspect oesophageal spasm
Dysphagia is constant and worsening
Suspect malignant stricture
Dysphagia - the neck bulges or gurgles on drinking
Suspect a pharyngeal pouch
Signs to look for in patient presenting with dysphagia
- is the patient cachexic or anaemic
- examine the mouth
- feel for supraclavicular nodes
- look for signs of systemic disease
What does an enlarged left supraclavicular node suggest?
Virchow’s node - suggests intra-abdominal malignancy
Dysphagia - investigations
- FBC (anaemia)
- U&Es (dehydration)
- Upper GI endoscopy +/- biopsy
- consider contrast swallow (pharyngeal pouch)
- oesophageal manometry for dysmotility
Symptoms of diffuse oesophageal spasm
intermittent dysphagia +/- chest pain
Achalasia pathophysiology
Coordinated peristalsis is lost and the lower oesophageal sphincter fails to relax due to degeneration of the myenteric plexus
Achalasia symptoms
- dysphagia
- regurgitation
- ↓ weight
Achalasia - characteristic findings on manometry or contrast swallow
dilated tapering oesophagus
Achalasia treatment
Endoscopic baloon dilation then proton pump inhibitors
Causes of benign oesophageal sphincter
- gastro-oesophageal reflux
- corrosives
- surgery
- radiotherapy
Treatment for benign oesophageal stricture
Endoscopic baloon dilation
Associations with oesophageal cancer
- male
- GORD
- smoking
- alcohol
- Barett’s oesophagus
Alarm symptoms
- Anaemia (iron deficiency)
- Loss of weight
- Anorexia
- Recent onset/progressive symptoms
- Melaena/haematemesis
- Swallowing difficulty